Surgical outcomes of open cholecystectomy in the laparoscopic era.
BACKGROUND
Although laparoscopic cholecystectomy has become the standard of care for symptomatic cholelithiasis and cholecystitis, 10% to 30% of cholecystectomies are still performed in open fashion. Because the total number of cholecystectomies is increasing with time, the average patient undergoing open cholecystectomy in the laparoscopic era is older and has more comorbidities.


METHODS
The records of 1629 consecutive patients who underwent cholecystectomy from July 1997 to September 2006 were evaluated. Analysis of variance, chi-square test, logistic regression, and linear regression were used to compare the following outcomes: length of procedure, length of stay, readmission (within 15 days and within 31 days), reoperation, and complication.


RESULTS
Major complications (death, bile duct injury, bile leak, or bleeding requiring reoperation or transfusion) occurred more frequently in laparoscopic cholecystectomy patients who were coverted to open procedure (5.9%) than in those who underwent open cholecystectomy (4.4%). Mortality rates were 2.9%, 1.5%, and 0% for open, converted, and laparoscopic cholecystectomy, respectively.


CONCLUSIONS
Older patients, male patients, and patients with previous upper abdominal surgery are at higher risk for mortality. They should be considered for open cholecystectomy given their increased likelihood of major complications when laparoscopic cholecystectomy is converted to open surgery.
Wolf
Andrea S
AS
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Nijsse
Bram A
BA
Sokal
Suzanne M
SM
Chang
Yuchiao
Y
Berger
David L
DL
D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome